Through-knee amputation is a feasible alternative to above-knee amputation

Area of Science:

• Vascular Surgery
• Orthopedic Surgery
• Rehabilitation Medicine

Background:

• Through-knee amputation (TKA) is a rare procedure (<2% of lower extremity amputations) despite biomechanical advantages over above-knee amputation (AKA).
• Surgeons have avoided TKA due to concerns about poor wound healing.

Purpose of the Study:

• To evaluate the surgical outcomes of through-knee amputation (TKA) compared to above-knee amputation (AKA).

Main Methods:

• A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (2005-2012) data.
• Comparison of 251 TKA cases with 7469 AKA cases using propensity score matching to control for comorbidities.
• Analysis of operative variables, postoperative complications, and 30-day mortality.

Main Results:

• Wound infection (11.2% vs 7.2%) and dehiscence rates (0.8% vs 1.2%) were comparable between TKA and AKA.
• 30-day mortality was similar (11.2% vs 9.6%), and not predicted by TKA or reoperation.
• TKA showed a higher reoperation rate (27.9% vs 12.4%), but patient's physiologic condition, not the amputation type, predicted mortality.

Conclusions:

• Through-knee amputation (TKA) demonstrates comparable postoperative morbidity and mortality to above-knee amputation (AKA).
• While TKA has a higher reoperation rate, it is a safe option for patients in stable condition without active infection, maximizing rehabilitation potential.